Marc a Provencher

Primary specialty

OptometristTaxonomy code 152W00000X

License

2025 Issued in CO

Legal business name

MARC A PROVENCHER

Practice address

4050 Timberline Rd
Suite 120
Fort Collins, CO 80525-6032

Phone

(970) 282-8888

Fax

(970) 282-8484

NPI assigned

Dec 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marc A Provencher, OD

Title

Doctor/Owner

Phone

(970) 282-8888

Specialties & licenses 1

Addresses

Other names 1

• Eyecare for You Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1275717266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 TIMBERLINE RD",
            "address_2": "SUITE 120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805256032",
            "telephone_number": "970-282-8888",
            "fax_number": "970-282-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 TIMBERLINE RD",
            "address_2": "SUITE 120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805256032",
            "telephone_number": "970-282-8888",
            "fax_number": "970-282-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARC A PROVENCHER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2010-01-12",
        "status": "A",
        "authorized_official_last_name": "PROVENCHER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "970-282-8888",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare for You",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gabriel Mansfield, RBT
• Mitchell Mansur
• Lauren Manzella, PMHNP
• Lauren A Maples, PH.D.
• Erin D Maranjian, NCMT,CLT-LANA
• Liza Marcelo
• David R Marchant, MD
• Marcie L Mata, LPC, LLC
• Mahalia Marcotte, M.D.
• Marley R Mardock

• Optometrist in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.